Today's Date: 09-07-2010

Personal Information:

Your Full Name:

Email Address:

Current Address:

City, State:    Zip:

Phone:    Referred By:

Are you under 18 years old?  Yes:  No:

Are you legally eligible for employment in the United States?  Yes:  No:

Employment Desired:

Position:	Location:	Salary/Wage:	Date you can Start:
Have you applied with us before?: NoYes    Where and When:

Availability:

Part-TimeFull-Time

M:

Tu:

W:

Th:

F:

Sa:

Su:

Education:

High School:		Years Attended:		Did you graduate?	Yes:
College:		Years Attended:		Did you graduate?	Yes:
Main fields of study/degree:
Post Graduate:		Years Attended:		Did you graduate?	Yes:
Main fields of study/degree:
Business or Trade School:		Years Atteneded:		Did you graduate?	Yes:
Main fields of study/degree:
Special study/training/skills:
US Military/Naval Service and Rank:
Skills relevant to desired position:
Computer Proficiency (Word, Excel, Access, etc...):

Former Employers: please list current/most recent employer first.

Employer:	Address:	Phone #:
Position:	Wage:	Type of Business:

Start/End Date:	Reason for Leaving:
Duties Performed:	Supervisor:

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Employer:	Address:	Phone #:
Position:	Wage:	Type of Business:

Start/End Date:	Reason for Leaving:
Duties Performed:	Supervisor:

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Employer:	Address:	Phone #:
Position:	Wage:	Type of Business:

Start/End Date:	Reason for Leaving:
Duties Performed:	Supervisor:

References: List the names of three professional references whom you have known for at least 1 year.

Name:	City,St:	Phone:
Business:	Relation to you:	Years known:

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Name:	City,St:	Phone:
Business:	Relation to you:	Years known:

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Name:	City,St:	Phone:
Business:	Relation to you:	Years known:

Additional Information:

What do you like about coffee/tea?
Why would you like to work for Alterra?
Describe your best customer service experience:
Anything else you would like to tell us?

Authorization: Please read below and check the box if agreed.

I agree:	"I certify that the facts contained in this application are true and complete to the best of my knowledge, and understand that falsification of these statements is grounds for dismissal. I authorize Alterra Coffee to confirm all statements made in this application and to contact previous employers and personal references."
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